海洛因成瘾者社区美沙酮维持治疗工作卫生经济学研究:美沙酮门诊收支分析

The Health Economics Evaluation on Community-based Methadone Maintenance Treatment for Heroin-addicts: Analysis on the Budget of Methadone Maintenance Treatment Clinics

目的:通过对首批8家美沙酮维持治疗门诊收支情况调查,应用微观经济学边际成本分析的方法,结合现场定性访谈,分析不同收费标准下门诊盈亏现状和问题,预测其运营的基本条件和最大收益,为管理层提供相关决策依据。方法:运用企业成本核算方法,在支出调查和成本核算的基础上,进行微观经济学边际成本定量分析。结果:(1)从收支测算结果看,在现行的收费和日均门诊量条件下,只有3家门诊可以实现收支平衡,并有一定的节余;其他门诊收不抵支。如果门诊仅依赖于上述中央和地方财政补偿的现况,没有服务收费,均将难以为继。(2)边际分析提示:按照10元/人日标准收费时,从8家门诊总的情况来看,日均门诊量需超过111人才可能实现保本;当日均门诊量达到365人时,门诊收益最大,但其在现行一定实际条件下很难达到。(3)按照5元/人日标准收费时,从总的成本投入来看,门诊难以保本。结论与建议:(1)收费定为不超过10元/人日,从稳定社会和保持门诊正常运营方面来看是合理和必要的。(2)基于本研究盈亏分析和现场调研的结果,建议尽快落实门诊的专项收支管理相应政策。

Objectives： This study is to investigate the budget of the eight clinics for methadone maintenance treatment （clinics for short） . The data from the investigation combined with qualitative interview results will be used to analyze the status and issues of the clinics for their own profits and losses in different charge standard, and predict the break-even point and the maximal profit point in order to give the suggestions to decision makers on the relative decision. Methods： Based on clinic＇s expenditures investigation and cost accounting, the study uses the method of marginal cost of microeeonomics to make an analysis. Results： （1） From the point of view of the budget calculation results, only three of the eight clinics can realize the balance of revenue and expenditure and have some surplus. Others can not make both ends meet. It is impossible that the clinic＇s operation only depend on the financial input from central and local public finance at a current level without their own business income. （2） Marginal analysis shows that the clinics realize the balance of revenue and expenditure only when the average outpatient amount per day reaches 111 person-time at the charge standard of RMBIO yuan per person per day. The maximal profit point is 365 person-fime of the average outpatient amount per day, which is difficult to reach in practice. （3） It is difficult for the clinics to balance the revenue and expenditure when the charge standard is RMBIO yuan per person per day. Conclusions： （1） Proceeding from social stability and normal operation of clinics, it is rational and necessary that clinics charge below RMB10 yuan per person per day from patients. （2） Based on above the breakeven analysis and field investigation results, we suggest that the management policy on specific revenue and expenditure of clinics should be implemented as soon as possible.